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SEC OR, 111felliallon ll III( - <br />WATER SAMPLE FIELD DAI A SHECI <br />a r <br />R'CT # 0) ) -1.�`�Y 1 ���'� <br />PURGED 13Y ',�y1 Wi I -L I D <br />-, -, 1 ),3 <br />SAM1'Ll [) BY -I' __ SAMPLE I D <br />NAMI <br />t QA SAh41'l I ti <br />ACATION K�#i c jj LLL <br />_k' <br />)ATE PURGED 4 j <br />SIAI (74Wl19) CND (24001st) —'-z <br />It <br />Zt <br />)ATESAMPLrD ;�l � t <br />SAM Pi I-iIML(240011 r) <br />;AMPLEOktlu <br />T-7 NC�koun Su ztct _� <br />�ll] IIs C ��r 1S(I kl 1FlliC [s1 Lfnucnt <br />-- — <br />4 5- G — h (dick �— <br />CASING DIA1,41-1I R2 2 -I- - <br />0 �+, (I G1 (I 07) {l 50) {2 60)( ) <br />{tlY1 1) ) <br />(- <br />Casing Volumc (fallow, I)cr foot) <br />_1 - — <br />- - <br />_ <br />CASING VOLUhSL Q -sl) <br />DEPTH TO 1301-1 OM (fccc) - rf _ <br />- <br />-LR '~7 <br />C <br />ALC,UI-Al LD PURG1 (} sl)EMI <br />`,`' I <br />(fccc) <br />EMI TO S�'A1_ <br />-- - <br />ATER COLUMN HEIG111 (fccc) <br />ACIUAL PURGE (gal) <br />FIELD MEASUREMENTS <br />DATE TIME VOLUME <br />TEMP CONDUCTIVI-1Y pH COLOR TURBIDITY <br />(units) ( Visu(N-17U)al (NU) <br />(2400hr) (gal) <br />(uml oslcni) <br />(degrees r)a. <br />tL <br />v,_ <br />SAMPLE I3 i?'ORMATION <br />SAMPLE TURB[DITY_ �---- <br />SAMPLE DEPTH TO WATER. <br />80% RECHARGE- OYES NO <br />ODOR � <br />PURGWG <br />Bladder Pump <br />Centrifugal Pump <br />Submersible Pump <br />Peristaltic Pump <br />Other <br />Pump Depth <br />WEU. INTEGRITY c0 <br />ANALYSES <br />SAMPLE VESSEL / PRESERVATIVE <br />'MENT Jnrvtri�s <br />Batter (Teflon) Bladder Pump <br />Bailer (PVC) Centrifugal Pump <br />Bailer (Stain[css Steel) Submersible Pump <br />Dedicated Peristaltic Pump <br />Odier <br />Bailer (Teflon) <br />Basler ( _PVC or - disposable) <br />Bailer (Stainless Steel) <br />Dedicated <br />LOCK# cJS — <br />Page — of <br />SIGNATURt <br />